BACKGROUND & AIMS: CONTEXT:Improved survival of children with cancer has been accompanied by multiple treatment-related complications. However, most studies in survivors of childhood cancer focused on only 1 late effect. OBJECTIVE:To assess the total burden of adverse health outcomes (clinical or subclinical disorders ["adverse events"]) following childhood cancer in a large cohort of childhood cancer survivors with long-term and complete medical follow-up. DESIGN, SETTING, AND POPULATION:Retrospective cohort study of 1362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996. All survivors were invited to a late-effects clinic for medical assessment of adverse events. Adverse events occurring before January 2004 were graded for severity in a standardized manner. MAIN OUTCOME MEASURES:Treatment-specific prevalence of adverse events (according to severity) at end of follow-up and relative risk of high or severe burden of disease (> or =2 severe or > or =1 life-threatening or disabling adverse events) associated with various treatments. RESULTS:Medical follow-up was complete for 94.3% of survivors (median follow-up, 17.0 years). The median attained age at end of follow-up was 24.4 years. Almost 75% of survivors had 1 or more adverse events, and 24.6% had 5 or more adverse events. Furthermore, 40% of survivors had at least 1 severe or life-threatening or disabling adverse event. A high or severe burden of adverse events was observed in 55% of survivors who received radiotherapy only and 15% of survivors treated with chemotherapy only, compared with 25% of survivors who had surgery only (adjusted relative risks, 2.18 [95% confidence interval, 1.62-2.95] and 0.65 [95% confidence interval, 0.46-0.90], respectively). A high or severe burden of adverse events was most often observed in survivors of bone tumors (64%) and least often in survivors of leukemia or Wilms tumor (12% each). CONCLUSIONS:In young adulthood, a substantial proportion of childhood cancer survivors already has a high or severe burden of disease, particularly after radiotherapy. This underscores the need for lifelong risk-stratified medical surveillance of childhood cancer survivors.

背景与目标：

BACKGROUND & AIMS: :This investigation examined differences in symptom patterns of two different trauma samples using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). MMPI-2s of 122 male combat veterans seeking outpatient treatment for combat-related PTSD were compared with those of 64 PTSD-diagnosed adults seeking outpatient treatment for the effects of child sexual abuse (CSA). We examined variables related to degree of health concerns, depression, somatization, anger and hostility, masculine-feminine traits, paranoid ideation, anxiety, difficulties thinking and concentrating, elevated mood, and social introversion, as well as test-taking attitude. MANOVAs revealed between-group differences on several variables. However, when analyses controlled for the effect of age, nearly all differences disappeared; the only remaining difference was in a scale measuring anger. Thus, it appears CSA survivors and combat veterans are much more similar than different in their clinical presentation on the MMPI-2. Conceptual issues in the assessment of PTSD are discussed.

背景与目标： : 这项调查使用明尼苏达州多相人格量表-2 (MMPI-2) 检查了两种不同创伤样本的症状模式差异。将122名寻求与战斗相关的PTSD进行门诊治疗的男性战斗退伍军人的MMPI-2s与64名经PTSD诊断为儿童性虐待 (CSA) 的门诊治疗的成年人进行了比较。我们研究了与健康问题程度，抑郁，躯体化，愤怒和敌意，男性女性特征，偏执观念，焦虑，思考和集中注意力的困难，情绪低落，社交内向以及应试态度有关的变量。MANOVAs揭示了几个变量的组间差异。但是，当分析控制了年龄的影响时，几乎所有差异都消失了。唯一剩下的差异是衡量愤怒的量表。因此，看来CSA幸存者和战斗退伍军人在MMPI-2上的临床表现要相似得多。讨论了PTSD评估中的概念问题。

BACKGROUND & AIMS: :Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal infectious disease, and it is endemic in Turkey. Patients are placed in isolation when hospitalized, and some may require blood transfusions. Moreover, some patients may require admission to intensive care units (ICU). CCHF is not a recurrent disease, and relapses are not expected. Therefore, no medical follow-up is conducted on recovery from CCHF. In this study, health-related quality of life (HRQL) and the presence of post-traumatic stress disorder (PTSD) among CCHF survivors were evaluated 12 months after recovery from the disease. PTSD diagnosis was established by DSM-IV-TR criteria and HRQL was investigated by using the Medical Outcomes Study Short Form 36. This study included 54 patients. Our results showed that 48.1% of the patients had PTSD symptoms and 18.5% had PTSD. PTSD incidence was higher among patients who required an ICU stay, who had bleeding, and who required blood transfusion. In addition, 4 out of 8 dimensions of HRQL were impaired. However, none of these patients admitted psychiatric problems to health care professionals. Our findings revealed that periodic psychiatric evaluation should be performed on CCHF patients, and they should be provided medical support, if required.

背景与目标： : 克里米亚-刚果出血发热 (CCHF) 是一种潜在的致命传染病，在土耳其很流行。患者住院时被隔离，有些患者可能需要输血。此外，一些患者可能需要入住重症监护病房 (ICU)。CCHF不是复发性疾病，预计不会复发。因此，没有对CCHF的康复进行医学随访。在这项研究中，在疾病康复后12个月评估了CCHF幸存者中与健康相关的生活质量 (HRQL) 和创伤后应激障碍 (PTSD) 的存在。根据dsm-iv-tr标准建立PTSD诊断，并使用医学结果研究简表36对HRQL进行调查。这项研究包括54名患者。我们的结果表明，48.1% 的患者有PTSD症状，18.5% 的患者有PTSD。在需要入住ICU、有出血和需要输血的患者中，PTSD发生率较高。此外，HRQL的8个维度中有4个维度受损。但是，这些患者中没有一个向医疗保健专业人员承认精神病。我们的发现表明，应对CCHF患者进行定期的精神病学评估，并在需要时向他们提供医疗支持。

BACKGROUND & AIMS: :When evaluating the risks of oncogenesis and cancer mortality following exposure to the radiations of the atomic bombs (A-bombs), the medical X-ray doses received by the A-bomb survivors must also be estimated and considered. Using a human phantom, dosimetry was performed to estimate the X-ray doses received by A-bomb survivors during medical examinations at the Radiation Effects Research Foundation (RERF) as part of the long-term follow-up on the Adult Health Study (AHS). These examinations have been estimated to represent nearly 45% of the survivors' cumulative medical irradiation dose. Doses to the salivary glands, thyroid gland, lung, breast, stomach and colon were measured using thermoluminescent dosimeters. The results, which are reported here, will aid in estimating organ doses received by individual AHS participants.

背景与目标： : 在评估暴露于原子弹 (A炸弹) 辐射后的致癌风险和癌症死亡率时，还必须估计和考虑A炸弹幸存者接受的医学x射线剂量。作为成人健康研究 (AHS) 长期随访的一部分，使用人体模型进行剂量测定，以估计在辐射效应研究基金会 (RERF) 进行医学检查期间原子弹幸存者接受的x射线剂量。据估计，这些检查占幸存者累积医疗照射剂量的近45%。使用热发光剂量计测量唾液腺，甲状腺，肺，乳房，胃和结肠的剂量。此处报告的结果将有助于估计各个AHS参与者接受的器官剂量。

BACKGROUND & AIMS: PURPOSE:Physical activity (PA) is an important adjuvant component in all phases of the cancer disease and PA is important for better functioning, coping with the situation and overall quality of life (QoL). In order to achieve better scientific knowledge of the effect of PA in cancer survivors, it is of paramount importance to have validated and feasible assessment tools for PA. METHODS:This validation study, which was part of an open intervention study, used a cross-sectional and a longitudinal design. The HUNT 1 physical activity questionnaire (HUNT 1 PA-Q) was compared to the International Physical Activity Questionnaire (IPAQ) and aerobic capacity. The participants were cancer survivors with different diagnoses attending an inpatient rehabilitation program partly focusing on physical training. RESULTS:The correlations between HUNT 1 PA-Q and IPAQ were 0.41 at pre-test and 0.57 at post-test, and sensitivity to change (effect size) was 0.42 for both questionnaires. VO(2 max) demonstrated high sensitivity to change (0.68) and low correlations with HUNT 1 PA-Q (0.30 at pre-test and 0.21 at post-test). There were 13 incomplete HUNT 1 PA-Q forms and 48 incomplete IPAQ forms during the study period. CONCLUSIONS:HUNT 1 PA-Q is considered suitable for use in cancer survivors and should be preferred to IPAQ because it was easier to fill in and provided more complete data. Aerobic capacity measures other aspect of PA and should be used as a supplement to PA questionnaire when the aim is to capture health effects related to aerobic capacity.

背景与目标：

BACKGROUND & AIMS: :We hypothesized an association between renal calculi and bone mineral density (BMD) deficits, shown in adults, exists in survivors of childhood acute lymphoblastic leukemia (ALL). Thus, we analyzed the associations between quantitative computed tomography (QCT)-determined renal calcifications and clinical parameters (gender, race, age at diagnosis and age at the time of QCT), BMD, treatment exposures and Tanner stage. We investigated the associations between stone formation and nutritional intake, serum and urinary calcium and creatinine levels, and urinary calcium/creatinine ratio. Exact chi(2)-test was used to compare categorical patient characteristics, and the Wilcoxon-Mann-Whitney test to compare continuous measurements. Of 424 participants, 218 (51.4%) were males; 371 (87.5%) were nonblack. Most (n=270; 63.7%) were >or=3.5 years at ALL diagnosis. Mean (s.d.) and median (range) BMD Z-scores of the entire cohort were -0.4 (1.2) and -0.5 (-3.9 to 5.1), respectively. Nineteen participants (10 males; 10 Caucasians) had kidney stones (observed prevalence of 4.5%; 19/424) with a significant negative association between stone formation and body habitus (body mass index, P=0.003). Stone formation was associated with treatment protocol (P=0.009) and treatment group (0.007). Thus, kidney stones in childhood ALL survivors could herald the future deterioration of renal function and development of hypertension. Long-term follow-up imaging may be warranted in these patients to monitor for progressive morbidity.

背景与目标： : 我们假设儿童急性淋巴细胞白血病 (ALL) 的幸存者中存在成人肾结石与骨矿物质密度 (BMD) 缺陷之间的关联。因此，我们分析了定量计算机断层扫描 (QCT) 确定的肾脏钙化与临床参数 (性别，种族，诊断时的年龄和QCT时的年龄)，BMD，治疗暴露和Tanner分期之间的关联。我们调查了结石形成与营养摄入，血清和尿钙和肌酐水平以及尿钙/肌酐比之间的关系。使用精确的chi(2) 检验比较分类患者特征，使用Wilcoxon-Mann-Whitney检验比较连续测量结果。在424名参与者中，218 (51.4%) 为男性; 371 (87.5%) 为非黑人。大多数 (n = 270; 63.7%) 在所有诊断中> 或 = 3.5年。整个队列的平均 (s.d.) 和中位 (范围) BMD Z得分分别为-0.4 (1.2) 和-0.5 (-3.9至5.1)。19名参与者 (10名男性; 10名白种人) 患有肾结石 (观察到的患病率为4.5%; 19/424)，结石形成与身体习性之间存在显着的负相关性 (体重指数，P = 0.003)。结石形成与治疗方案 (P = 0.009) 和治疗组 (0.007) 相关。因此，所有幸存者在儿童时期的肾结石可能预示着肾功能的恶化和高血压的发展。这些患者可能需要长期随访影像学检查以监测进展性疾病。

BACKGROUND & AIMS: :Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired t-test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps (t = -3.5341; P = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week (p value <0.0001) and decreased DT scores by 0.77 per week (p value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 (p value <0.0001) and decrease in weekly DT by 0.73 (p value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Trial Registration: NCT03190720, NCT03072966.

背景与目标： : 增强体力活动 (PA) 和减少精神困扰是癌症幸存者护理中的重要问题。移动技术作为一种改变健康行为的新兴方法，正受到许多研究人员的关注。这项研究旨在调查基于移动应用程序的社区对增强PA和减少乳腺癌幸存者痛苦的影响。我们进行了一项非随机，前瞻性，干预性研究，其中包括移动社区-后期arm和移动社区-第一arm。使用安卓智能手机应用程序 (WalkON®)，使用基于应用程序的遇险温度计 (DT) 问卷从参与者那里收集了约12周的每日步行步骤和每周遇险评分。为了检查社区活动之前和期间每周步数的差异，我们使用了配对t检验方法。为了进行比较分析，我们参考了以前的前瞻性观察性研究，而没有移动社区干预，其设置与本研究相同。在倾向得分匹配 (PSM) 之后，进行具有差异差异 (DID) 的多变量回归建模，以估计基于移动应用程序的社区对PA和精神困扰的影响。从1月到2018年8月，共有64名参与者参加了这项研究。在单变量分析中，参与移动社区后，参与者显示每周总步数显着增加 (t = -3.5341; P = 0.00208)。差异的平均值为10,408.72步。在PSM之后的多变量分析中，在混合效应模型中，移动社区每周显着增加8,683.4步 (p值 <0.0001)，每周减少0.77 (p值 = 0.009)。在双向固定效应模型中，移动社区显示每周步长显着增加8,723.4 (p值 <0.0001)，每周DT显着减少0.73 (p值 = 0.013)。基于移动应用程序的社区是一种有效且资源消耗较少的工具，可提高PA并减少乳腺癌幸存者的痛苦。试注册: NCT03190720，nct03072966。

BACKGROUND & AIMS: OBJECTIVE:The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. METHODS:In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. RESULTS:20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). CONCLUSIONS:The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences.

背景与目标：

BACKGROUND & AIMS: Purpose:This study evaluated differences and shifting patterns in the health-related quality of life (HRQoL) of 5-year gastric cancer survivors after either a distal subtotal gastrectomy (DSG) or total gastrectomy (TG). Materials and Methods:We analyzed the prospectively collected HRQoL data of 528 patients who survived 5 years without recurrence using the European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Quality of Life Questionnaire-Stomach module according to the type of surgery. The purpose was to identify the proportion of patients with deteriorating HRQoL and to assess the clinical significance of these changes. Results:Deteriorating HRQoL was prevalent in both groups, including a large proportion of the DSG group. Decreased overall health status and scores on several function scales were less in the DSG group, while increases on the symptom scales were higher in the TG group. For most of the scales, gaps in HRQoL during the early postoperative period did not merge within the 5 years. Scores on the diarrhea and body image scales revealed "moderate changes" in both groups. Conclusions:During the 5-year period after surgery, the TG group suffered from inferior HRQoL compared to the DSG group. However, a large proportion of the DSG group also suffered HRQoL deterioration. In general, the TG group experienced more HRQoL decline, with diarrhea and body image being the major concerns for both groups. To improve HRQoL after gastrectomy, patients must be better informed about post-gastrectomy symptoms. These symptoms must be vigorously investigated, and medical interventions should be available parallel to nutritional support. Favorable evidence of function-preserving gastrectomy should be established and disseminated to improve the HRQoL of early gastric cancer patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE:This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS:Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS:In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS:This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION:PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With increased cure, childhood cancer survivors are reaching adulthood and seeking employment. Host, disease and treatment risk factors may contribute to inability to attain or maintain employment. PROCEDURE:The prevalence and risk factors for unemployment were evaluated using self-reported employment history in 10,399 childhood cancer survivors and 3,083 siblings >/= age 18 in the Childhood Cancer Survivor Study (CCSS). RESULTS:Among survivors, 5.6% reported unemployment, compared with 1.2% of siblings (odds ratio [OR] 3.7; 95% confidence interval [CI] 2.6, 5.1). Increased risks were observed within all cancer diagnoses. In multivariate analysis, diagnosis of central nervous system (CNS) tumor (OR 1.5; 95% CI 1.1, 2.1), bone cancer (OR 1.5; 95% CI 1.0, 2.1), treatment with >/=30 Gy cranial radiotherapy (OR 4.0; 95% CI 2.9, 5.5), female gender (OR 1.4; 95% CI 1.2, 1.7) and age < 4 years at diagnosis (OR 1.4; 95% CI 1.1, 1.8) increased risk. Diagnosis of CNS or bone tumor or cranial radiotherapy >/=30 Gy remained significant after adjusting for treatment, medical late effects, age and gender. Risk of unemployment decreased with attained age (OR((year)) 0.89; 95% CI 0.87, 0.91). CONCLUSIONS:Compared to siblings, adult childhood cancer survivors are at increased risk for unemployment with highest risk defined by diagnosis, treatment and demographic factors.

背景与目标：

BACKGROUND & AIMS: PURPOSE:Online communities have been heralded as one of the most promising health resources on the Internet. The purpose of this study was to identify the characteristics and levels of use of online communities for breast cancer survivors. METHODS:Using Google, we identified websites with a string of computer-mediated communication terms and individual queries of three to five words of online community terms. This was complemented by a review of website resource lists and personal libraries. Two reviewers independently extracted information on their general characteristics and number of members and message board posts. A coding scheme guided content analysis. RESULTS:We found 111 websites. Most sites (n = 64, 65.8 %) had a broad focus (e.g., health, cancer, or general). One third (n = 38, 34.2 %) were exclusive to breast cancer and 11 catered to specific disease characteristics. The majority were American (n = 79, 75.2 %), nonprofit (55.0 %), and moderated (69.5 %). Most moderators (85.7 %) were staff or community members; eight sites were moderated by health professionals. Greater than one-third of sites (n = 40, 36 %) were initiated by breast cancer survivors or loved ones. Breast cancer-specific sites contained a total of 4,186,275 posts. One-third (n = 10) contained 93.4 % of posts, displaying over 100,000 posts each. As of April 3, 2012, eight sites were discontinued. CONCLUSIONS:There is a wide range of online communities available for breast cancer survivors with extensive archives of personal illness experiences. Future efforts should focus on identifying the factors that determine their success and effectiveness.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Long-term medication therapy for patients with post-myocardial infarction (MI) can prolong life. However, recent data on long-term adherence are limited, particularly among some subpopulations. We compared medication adherence among Medicare MI survivors by disability status, race/ethnicity, and income. METHODS:We examined 100% of Medicare fee-for-service beneficiaries discharged post-MI in 2008. The outcomes were adherence to β-blockers, statins, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, for 1-year and 6-month postdischarge. Adherence was defined as having prescriptions in possession for ≥75% of days. RESULTS:Among aged beneficiaries who survived 1-year adherence to β-blockers were 68%, 66%, 61%, 58%, and 57% for whites, Asians, Hispanics, Native Americans, and blacks, respectively; among persons with disability, 1-year adherence was worse for each group: 59%, 54%, 52%, 47%, and 43%, respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location, and health status. Patterns of adherence to statins and angiotensin-converting enzymes/angiotensin II receptor blockers were similar. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to whites: odds ratio 0.70 (95% CI 0.65-0.75) for blacks and odds ratio 0.70 (95% CI 0.55-0.90) for Native Americans. CONCLUSIONS:Although β-blockers at discharge has improved since the National Committee for Quality Assurance implemented quality measures, long-term adherence remains problematic, especially among persons with disability and minority beneficiaries. Quality measures for long-term adherence should be created to improve outcomes in patients with post-MI. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.

背景与目标：

BACKGROUND & AIMS: :Cardiac transplantation is predicted to improve survival for patients with severe symptoms of heart failure and ejection fraction of 20% or less, but the exercise capacity after cardiac transplantation is less than normal. Patients responding to vasodilators and diuretics have progressive improvement in exercise capacity despite low ejection fraction. We hypothesized that among patients currently considered appropriate for transplantation who could nonetheless subsequently be stabilized on medical therapy tailored to hemodynamic goals, survivors after 6 months of sustained medical therapy would demonstrate exercise capacity comparable to that of survivors of transplantation. Of 146 patients referred, 118 (81%) were discharged on tailored therapy without transplantation, and 88 (60%) were stable for at least 1 month. Stability after discharge was more likely in patients with lower right atrial pressures and better renal function on therapy. Of the 88 stable patients, 45 patients were listed for transplant, and 43 were ineligible or unwilling. From these patients, 42 survivors for more than 6 months follow-up after cardiac transplantation or tailoring of medical therapy underwent exercise testing. Baseline functional and hemodynamic status and left ventricular ejection fraction (15 +/- 4%) were not different between the transplant and sustained medical survivor groups at the time of initial evaluation. After 14 +/- 6 months, left ventricular ejection fraction had increased to 62 +/- 7% after transplantation (p less than 0.01) and only 22 +/- 9% after sustained medical therapy (p less than 0.05). However, there were no significant differences in the maximum workload, oxygen uptake, anaerobic threshold, or maximum oxygen pulse between survivors of cardiac transplantation and survivors on sustained medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

背景与目标： : 对于严重的心力衰竭症状和射血分数20% 或更低的患者，心脏移植有望提高生存率，但心脏移植后的运动能力低于正常水平。尽管射血分数低，但对血管扩张剂和利尿剂有反应的患者的运动能力逐渐改善。我们假设，在目前认为适合移植的患者中，尽管随后仍可以根据血液动力学目标进行药物治疗而稳定下来，持续药物治疗6个月后的幸存者将表现出与移植幸存者相当的运动能力。在146例转诊患者中，118例 (81% 例) 在没有移植的情况下接受定制治疗出院，88例 (60% 例) 稳定至少1个月。右心房压力较低且治疗后肾功能较好的患者出院后更可能保持稳定。在88名稳定患者中，有45名患者被列入移植名单，而43名患者不合格或不愿意。在这些患者中，有42名幸存者在心脏移植或药物治疗定制后进行了6个月以上的随访，并进行了运动测试。在初始评估时，移植组和持续医学幸存者组之间的基线功能和血液动力学状态以及左心室射血分数 (15/- 4%) 没有差异。14 +/- 6个月后，移植后左心室射血分数增加到62 +/- 7% (p小于0.01)，持续药物治疗后仅增加到22 +/- 9% (p小于0.05)。然而，心脏移植幸存者和持续药物治疗幸存者在最大工作量、摄氧量、无氧阈值或最大氧脉搏方面没有显著差异。(摘要截短于250字)

BACKGROUND & AIMS: :Survivors' information-seeking behavior has traditionally been documented through analysis of inquiries to hotlines and cancer information services. Data from these self-selected inquiries tend to be restricted to a time around diagnosis, and to those populations possessing the wherewithal and motivation to seek information actively. The current study used data from a general population survey to assess 1) the prevalence of information-seeking behavior among survivors in the general population, 2) characteristics of seekers versus nonseekers, 3) ratings of information-seeking experience, and 4) actual versus preferred sources of information. Data were analyzed from the 2005 administration of the Health Information National Trends Survey (HINTS). HINTS is a cross-sectional, random digit dial telephone survey, weighted to provide estimates for the general population. Nearly half of all Americans (48.7%) indicated that they have looked for cancer information from 1 source or another. Percentages were highest for those who have been touched by cancer (63.1% of cancer survivors and 54.6% of those with family histories) and lowest for those with no cancer history (27.6% of those with no history). Quality concerns topped the list of information-seeking experiences for those recalling the last time they looked. Patterns of information-seeking revealed a discrepancy between preferred and actual source when tracked over years since diagnosis. Information-seeking is prevalent among cancer survivors and does not diminish over time. Prescriptions are given for reengineering the information environment to improve long-term outcomes for survivors.

背景与目标： : 幸存者的信息寻求行为传统上是通过分析热线和癌症信息服务的查询来记录的。来自这些自我选择的查询的数据往往仅限于诊断前后的时间，以及那些拥有主动寻求信息的资金和动力的人群。当前的研究使用了来自一般人群调查的数据来评估1) 一般人群中幸存者中信息寻求行为的普遍性，2) 寻求者与非寻求者的特征，3) 信息寻求经验的等级，以及4) 实际与首选信息来源。数据分析来自2005健康信息管理局国家趋势调查 (HINTS)。HINTS是一项横断面的随机数字拨号电话调查，经过加权后可提供一般人群的估计。近一半的美国人 (48.7%) 表示，他们从1个或另一个来源寻找癌症信息。受癌症影响的人 (癌症幸存者的63.1% 和有家族史的人的54.6%) 的百分比最高，没有癌症病史的人 (没有病史的人的27.6%) 的百分比最低。对于那些回忆上次看的人来说，质量问题在寻求信息的经历中名列前茅。自诊断以来的多年追踪，信息寻求模式显示出首选来源与实际来源之间的差异。信息寻求在癌症幸存者中很普遍，并且不会随着时间的推移而减少。给出了重新设计信息环境以改善幸存者的长期结果的处方。